Gluteal retractions: classification and treatment techniques.

Abstract

The buttocks can be affected by many different kinds of retractile notches, all of them caused by histologic alterations of the subcutaneous tissues, gluteal fascia, or muscle at different levels of severity. Until now, no attempt has been made to systemize the diagnosis of these defects or to describe a treatment approach from the aesthetic viewpoint. We present a definition and a classification of gluteal retractions based on the anatomic structures affected, the assessment used to identify each type of defect, and the techniques used to correct different problems. The affected muscle fibers or fibrous fascial segments were lysed and removed through an incision on the intergluteal crease, under epidural block. Subcutaneous defects were treated percutaneously by fat grafting and fiber lysis and addressed under local anesthesia or epidural anesthesia when combined with correction of a muscular or fascial retraction. Treatment results in a series of 214 patients were satisfactory. Complications included seroma in 2 cases of fascial fibrosis, 1 of which was followed by infection; residual inelastic muscle fibers in 2 cases; overcorrection in 8 cases; and infection in 1 case of fat grafting. In 31.2% of patients with subcutaneous defects, more than one fat grafting session was required to correct subcutaneous defects. The classification system and algorithm based on physical examination presented here for the treatment of gluteal retractions have been shown to be useful tools for diagnosis and treatment of specific types of defects.